Doulas Make a Difference

January 22, 2008 9:11 am by Amy Gates in Family

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"If a doula were a drug, it would be unethical not to use it." -- John H. Kennell, MD

If I could do my daughter's birth all over again - a birth that, because of a pregnancy complication I developed (HELLP syndrome), included numerous interventions - I would have hired a doula. I'd done my birth homework and for some reason I didn't think I needed one nor could afford one, but as I have since learned, having the right doula at your birth can be worth her weight in gold. I think if I had had a doula present at Ava's birth, I would have come away from the experience feeling like I had been better informed (we were left in the dark about so many things) and more of an active participant in my labor instead of a passive recipient. But as the saying goes, live and learn. I have learned and now I will share what I've learned with you.

‘Doula’ (pronounced doo-la) is a Greek word meaning "woman’s servant." Doulas are trained and experienced in childbirth, though they do not handle the medical aspects of it; those are reserved for a midwife or doctor. The role of a birth doula is to provide support for the woman and her partner during labor and birth. This support may include physical support such as suggesting different positions for laboring, giving massages or instructing the woman's partner how to massage her, breathing with her, getting food and drinks for the woman and her partner, etc.; emotional support in the form of reassurance and comfort; as well as informational support such as explaining different medical options, risks and benefits, and possibly suggesting natural techniques to achieve the same results. It is often said that a doula mothers the mother.

The 'Enjoy Birth' blog has a post called "Get a birth doula" that explains the type of support a doula can offer including:

Resource for Comfort Measures: Having a doula is like having your very own talking birthing guide. Doulas know what can help during birth and how to do it. Your doula can either perform these comfort measures herself, or help your family or friends to support you with comfort measures. Your birth partners will feel more confident knowing that they are doing the right thing.
Constant Encourager: A doula not only encourages the mother to keep going, but she encourages the labor support to keep going as well. The process of labor can sometimes be long. A doula can keep you and your partner focused during the most intense part of labor.
Helps Explain Options: A doula is also a source of information about ways to handle your birth. Medical attendants don’t always have time to get into all the options available, and rarely give all the risks and benefits for the options they do give. A doula can help you understand what options are available, and what the pros and cons are. This can help you make better informed decisions.

There are many benefits to having a doula attend your birth.

Proven Benefits of Doula Care

Decreased medical intervention in labor*:

• Reduces need for cesarean by 50%
• Reduces length of labor by 25%
• Reduces use of artificial oxytocin (pitocin) by 40%
• Reduces pain medication use by 30%
• Reduces the need for forceps by 40%
• Reduces epidural requests by 60%

Six weeks after birth, mothers who had doulas were**:

• Less anxious and depressed
• Had more confidence with baby
• More satisfied w/ partner (71% vs 30%)
• More likely to be breastfeeding (52% vs. 29%)

*These statistics appear in “A Doula Makes the Difference” by Nugent in Mothering Magazine, March-April 1998.
**Statistics from What is a Doula?

I've heard countless stories from women I know - both in person and on the Internet - singing the praises of their birth doulas. Every one of them feels their birth experience was more positive as a direct result of the support offered by their doula.

Alma from Chicago Moms Blog reflects on her birth and the help she received from her doula - "her hero" - in her post Not Without My Doula.

"It (labor) was really hard, and I couldn't have done it without the support of my doula, Tricia Fitzgerald. ... her dedication and support was worth far more [than] the typical going rate for a doula.

She also squelches the myth that a doula tries to take the place of a woman's husband or partner.

Doulas don't monitor or deliver babies; they're dedicated to mothering the mother, helping her achieve the birth experience she wants. And contrary to what some people think, your doula will not displace your husband. Rather, she just may keep you from cursing out your well-meaning partner who just can't seem say the right thing or rub you the right way."

I think it takes a very special kind of woman to be a doula and Leigh, a fairly new doula and mother of two young daughters, is definitely one of those special women. Leigh writes beautifully about each of the births she attends on her blog Mere Mortal Mama and I soak up every one of them. She seems to possess an ancient wisdom that allows her to be extremely in-tune with her clients. She is committed to helping them achieve the birth they desire. Here's an excerpt from her most recent birth, that of a teen mother:

And then that moment comes; the moment when you notice the slight shift in energy of the room and know it is time to be fully present for your client. I glue myself next to the bedrail and remain over her for the duration of labor. I breathe in deeply with her and exhale slowly, offering the most hushed of encouraging words. We establish a pattern together quickly: we breathe, she cringes and tightens her brow a bit, I press a firm thumb on her forehead and smooth her brows, she relaxes and breathes out. I stroke her hair as the surges release; she lets out a cleansing breath. Our fingers entangle as she rests between the surges.

I whisper breathy words and phrases into her ear and have no idea where they are coming from. Upon speaking some of them, her head nods in barely perceptible understanding – her eyelids fluttering closed - and so I stick with those.

And it is those moments where ego and heart humbly meet, swollen like a balloon about to burst. Two women, in rhythm to the song of labor, swaying into words and sinking into breath; connected through the pulse of birth.

I believe that - "two women ... connected through the pulse of labor" - sums up simply and perfectly what the experience of having a doula is meant to be. I think that all women and their partners should consider giving themselves the gift of a doula.

To learn more about doulas, including how to find one in your area and questions to ask when interviewing a doula, see the additional resources below.

Additional resources:
DONA (Doulas of North America) International - Learn more about doulas as well as find doulas in your area
CAPPA: Childbirth and Postpartum Professional Association
How to hire a doula - Questions to ask
How Dads/Partners and Doulas can work together to support the birthing mother
Information about Postpartum Doulas who's role is to help a woman through her postpartum period and to nurture the family

Contributing editor Amy Gates also blogs about attachment parenting, activism, green living and photography atCrunchy Domestic Goddess.

Why your due date isn't what you think it is...

by: Misha Sanfranski
associatedcontent.com


We have it ingrained in our heads throughout our entire adult lives-pregnancy is 40 weeks. The "due date" we are given at that first prenatal visit is based upon that 40 weeks, and we look forward to it with great anticipation.


 When we are still pregnant after that magical date, we call ourselves "overdue" and the days seem to drag on like years. The problem with this belief about the 40 week EDD is that it is not based in fact. It is one of many pregnancy and childbirth myths which has wormed its way into the standard of practice over the years-something that is still believed because "that's the way it's always been done". 

The folly of Naegele's Rule

The 40 week due date is based upon Naegele's Rule. This theory was originated by Harmanni Boerhaave, a botanist who in 1744 came up with a method of calculating the EDD based upon evidence in the Bible that human gestation lasts approximately 10 lunar months. The formula was publicized around 1812 by German obstetrician Franz Naegele and since has become the accepted norm for calculating the due date. There is one glaring flaw in Naegele's rule. Strictly speaking, a lunar (or synodic - from new moon to new moon) month is actually 29.53 days, which makes 10 lunar months roughly 295 days, a full 15 days longer than the 280 days gestation we've been lead to believe is average. In fact, if left alone, 50-80% of mothers will gestate beyond 40 weeks. 

Variants in cycle length

Aside from the gross miscalculation of the lunar due date, there is another common problem associated with formulating a woman's EDD: most methods of calculating gestational length are based upon a 28 day cycle. Not all women have a 28 day cycle; some are longer, some are shorter, and even those with a 28 day cycle do not always ovulate right on day 14. If a woman has a cycle which is significantly longer than 28 days and the baby is forced out too soon because her due date is calculated according to her LMP (last menstrual period), this can result in a premature baby with potential health problems at birth. 

The inaccuracy of ultrasound
First trimester: 7 days

14 - 20 weeks: 10 days 

21 - 30 weeks: 14 days 

31 - 42 weeks: 21 days 
Calculating an accurate EDD

Recent research offers a more accurate method of approximating gestational length. In 1990 Mittendorf et Al. undertook a study to calculate the average length of uncomplicated human pregnancy. They found that for first
time mothers (nulliparas) pregnancy lasted an average of 288 days (41 weeks 1 day). For multiparas, mothers who had previously given birth, the average gestational length was 283 days or 40 weeks 3 days. To easily calculate this EDD formula, a nullipara would take the LMP, subtract 3 months, then add 15 days. Multiparas start with LMP, subtract 3 months and add 10 days. The best way to determine an accurate due date, no matter which method you use, is to chart your cycles so that you know what day you ovulate. There are online programs available for this purpose (refer to links in resources section). Complete classes on tracking your cycle are also available through the Couple to Couple League


ACOG and postdates

One of the most vital pieces of information to know when you are expecting is that ACOG itself (American College of Obstetricians and Gynecologists) does not recommend interfering with a normal pregnancy before 42 completed weeks. This is why knowing your true conception date and EDD is very important; if you come under pressure from a care provider to deliver at a certain point, you can be armed with ACOG's official recommendations as well as your own exact due date. This can help you and your baby avoid much unnecessary trauma throughout the labor and delivery. Remember, babies can't read calendars; they come on their own time and almost always without complication when left alone to be born when they are truly ready. 
Sources: 

Mittendorf, R. et al., "The length of uncomplicated human gestation," OB/GYN, Vol. 75, No., 6 June, 1990, pp. 907-932. 
ACOG Practice Bulletin #55: Clinical Management of Post-term Pregnancy

"Signs I missed that my practicioner would not support a natural birth"

It’s been eleven months and two and a half weeks since I gave birth to my son Oliver. Almost a year now and I am still not able to talk about my birthing experience in any detail. To say I was disappointed with my birthing experience is a gross understatement, and as the months go by and I start to open up about that experience more and more I am coming to realize that I am not the only one.

I have read a lot in the past year about the business of birth; about the rising cesarean rate, about women being refused their right to informed consent, doctors and nurses who do not take a woman’s autonomy seriously, women who have their children taken from them for refusing to allow that autonomy to be ignored. and about women who's birth experiences go far beyond disappointment and trauma. It seems to me that what should be one of the greatest days of a woman’s life is too often a nightmare. I was vaguely aware that stories like these existed before I had Oliver, but I am realizing that I was not really as equipped as I could have been to prevent it happening to me.

I am still not ready to talk about my birthing experience in detail. But nearly a year later I have begun to look back at the months leading up to that experience. Hind sight being 20/20 I have come to realize that there are quite a few signs I missed that my OBGYN and I were not on the same page, or even reading the same book, when it came to my labour and birth. I am sharing these flags in no particular order, and hope that it may help others to accurately gage whether the practitioner they are choosing is right for them.

1) When I stated my intention to breastfeed and informed my practitioner that I would like to forgo an epidural to ensure my child and I were alert and healthy enough to do so immediately following birth I was told by my practitioner that an epidural, or even the type of birth I had would not have any effect on breastfeeding.

Despite all of the reading I had done about breastfeeding from a number of valid sources that said otherwise, I believed what my doctor said to be true. After all, he was a doctor right? What I did not realize at the time was that my practitioner was either ignorant to or lying about the risks and side effects of the epidural and other interventions.

2) At one point, I asked my practitioner what his cesarean rate was in an effort to gage the likelihood that he would intervene unnecessarily in my labour and birth. Looking back I now realize that he never did give me a straight forward answer, but instead told me: “I don’t want you to have a C-Section, because then I wouldn’t get to deliver your next baby.” This answer was comforting to me then, it made me trust him, made me think that he and I were on the same team and that we wanted the same things.

But, as any woman who has ever had or planned to have a VBAC or HBAC knows, this answer was probably the worst one my practitioner could have given me. The fact that my practitioner was either unaware of or did not believe that vaginal birth after cesarean section was an option,despite mounting evidence and changing perceptions in the medical community, should have made it glaringly obvious to me that my practitioner would be making decisions based in myth and tradition and would not be providing me with evidence based care.

3) When I first heard of a Doula I had no idea what a Doula was for, so I asked my practitioner. “You don’t need one” he said “That’s what your husband is for”. I should have laughed in his face, instead what happened was my husband turned to me and said “I’ll be there for you honey, you can trust me to take care of you”.

I really do trust my husband to take care of me, and when it came time he did the absolute best that he knew how. But here’s the thing about relying on your partner to act as a doula: Not only does your partner likely have the exact same amount of knowledge and experience with labour and birth as you do, it’s also incredibly unfair. Chances are the birth of your child will be just as emotional, overwhelming, and life changing for your partner as it will be for you, you cannot expect them to give you calm and rational advise 100% of the time, and you cannot expect them to know how to help you in every situation that could arise, especially if anything goes wrong, they will not be capable of providing a calm, and rational opinion for you.

My practitioner was either relying on those facts to make sure he wasn’t questioned or stood up to in the delivery room, or he really didn’t understand the roll of a doula. Any practitioner who downplays or doesn’t understand the roll of a doula, or worse isn’t willing to work with one, is likely not interested in giving you the birth you want.

4) As my due date drew closer and closer and I started to get more and more nervous about giving birth I wrote myself a birth plan. It was a large print colour coordinated spreadsheet with very clear wording about what I did and did not consent to during my labour and birth. My practitioner never once used the word “birth plan”, he called it a “wish list” and told me to keep an open mind and be flexible just in case something went wrong.

I am sure now that he didn’t even look at let alone the laminated copy we gave him to put in my file. I know this because when the labour and delivery nurses called him to tell him that I was at the hospital and in active labour he told them to offer me an epidural, despite the fact that my birth plan stated in bold red letters on the very front page not to actively offer me pain relief and that I would ask for it if I wanted it.

A birth plan is so very much more than a wish list, and the fact that my practitioner was not interested in what *I* wanted or what *I* would or would not consent to should have been the biggest warning sign of them all. It should have been obvious to me from that moment that this man had no intention of respecting my autonomy when I went into labour.

I am not sure why I didn’t see these signs for what they were when I was pregnant and preparing for birth. It takes a great amount of effort not to blame myself for the way my birthing experience turned out because I didn’t notice these things.

Maybe I went into it a little over confident in my own strength without really appreciating what it would mean to give birth. I truly did believe that it didn’t matter what my doctor wanted, that I could just say ‘no’ to anything I didn’t want, even if I were scared, vulnerable and overwhelmed. Maybe I was unable to see these signs, or somehow chose not to see, or repressed them because of all the stress and anxiety I was already feeling.

At the very least I know now what I need to look for in a practitioner when we decide to have another baby. I will know next time that the practitioner you choose does have a very large part to play in the kind of experience you come away with, and that pure stubbornness isn’t enough to rely on.

I still struggle very much with how the birth of my son played out. I imagine it will take me a very long time to work through the self blame, and the anger, and the sadness and disappointment, but I do look forward to the next time. I feel as though I have learned a great many lessons from that experience. Not only about the kind of practitioners I want to help me the next time, but about the things I want to get out of my birthing experience and my own strengths and vulnerabilities. I cannot change the birth I have already had, but I feel very hopeful about the next one, whenever that may be.